HBI3ZI 



1321 , Mi^ . ^ ^ 

B 

y 1 



The Chances of Death and the 
Ministry of Health 



Frederick L. Hoffman, LL. D. 



Statistician 
The Prudential Insurance Company 

of America 

4 



/ 

518619 



Address delivered before the Divinity School, Yale University, 
New Haven, Conn., March 30, 1914 



THE CHANCES OF DEATH AND THE 
MINISTRY OF HEALTH 

The Functions of Modern Medicine 
The problems of death and the duration of hfe have at all times been 
the subject of much profound speculation and theoretical as well as 
practical analysis. The average as well as the maximum attainable 
duration of human life must needs be a matter of serious concern to the 
individual and the state. The mortality experience of mankind in the 
mass reflects, with admirable accuracy, the attained degree of civiliza- 
tion as exemplified in the human control of the death rate; or, in other 
words, the prevention and successful elimination of diseases due to un- 
favorable external and controllable conditions affecting the duration of 
life. The day has passed forever when the average duration of life was 
complacently accepted as preordained or a matter of pure chance. In 
place of a fatalistic conception of death, a new doctrine of social and 
individual control of the death rate prevails, which accounts for the 
material improvement in health and longevity, which, by trustworthy 
records, is shown to have taken place throughout practically the entire 
civilized world within a comparatively brief period of time. This mar- 
velous change may properly be considered one of the wonders of modern 
science and a human achievement transcending, in its far-reaching practi- 
cal importance and enormous benefit to millions of mankind, all of the 
other great inventions combined. The modern control of the human 
death rate is due chiefly to the results of systematic scientific research 
and, to an increasing degree, of individual and social conformity to the 
teachings of natural laws and facts disclosed by the discoveries of pre- 
ventive medicine. The domain of medicine is no longer considered 
exclusively the province of the physician, whose functions are limited to 
its practice as a healing art. Modern conceptions of public health and 
sanitary science have enormously broadened the field of medicine in 
general and brought the teachings of its principles within the understand- 
ing of the mass of the people of ordinary intelligence. We are apt to 
think contemptuously of the practices of the Medicine Man of our native 
Indians, but in very truth the gulf which separates primitive medicine 
from modern surgery is not as wide as the gulf which separates the funda- 
mental conceptions of preventive medicine from those of medicine limited 
in its functions to a healing art. The modern doctrine that diseases on 
a large scale can be prevented and that some can be entirely eliminated 



is as new to the world as the marvels of wireless telegraphy or practical 
aviation. The prayer of the Christian Church, "From plague, pestilence, 
and famine, good Lord, deliver us," is, in modern life, translated into the 
social and personal duty of effective conservation and public sanitary 
control. Epidemics, which in the past were often responsible for an 
enormous loss of human life, are no longer a constant menace to human 
happiness and a hindrance to the attainment of normal old age on the 
part of the many who now in health and vigor reach the Biblical period 
of threescore years and ten. Vast areas of the world are still subject 
to the ravages of cholera, plague and fevers, but gradually the area of 
effective sanitary administration is being enlarged, and, in civilized coun- 
tries at least, the general death rate has been declining, until it has now 
reached the lowest point in the recorded history of mankind. Further 
improvements in health and sanitation are within the range of human 
achievement, and there is the strongest possible evidence to warrant the 
hope that within another generation most of the so-called preventable 
diseases will be entirely and effectively subject to human control. The 
relation of the death rate to history is not a fanciful suggestion, for there 
is increasing evidence, as the records of the past are studied, to warrant 
the conclusion that the fate and fortunes of mankind have been more 
often determined by the health and physical vigor of the inhabitants 
of great nations than by the wisdom or the lack of wisdom of kings and 
queens whose names are enshrined forever in the annals of time. 

The mystery and the terror of death have at all times aroused the 
human imagination to fanciful conceptions, to elaborate funereal offer- 
ings and to an allegorical portrayal of life's slender chances, as best shown 
in the picturesque literaiAire of the Dance of Death. Hans Holbein, the 
painter, ranks foremost in the effort to visualize the images and aspects 
of death in the lives of the rich and the poor, the powerful and the humble, 
the good and the bad, the old, the middle-aged and the young. Dagley, 
in 1826, portrayed death's doings by means of numerous original compo- 
sitions in prose and verse, commencing with an allegory of the bubbles 
of life broken by Death, and including some exceedingly interesting 
observations on life assurance and the philosophical observation, justified 
by experience, "That man can not be a very worthless member of the 
community, whose natural affection induces him to deny himself all or 
many of the luxuries of life, and in some cases even to abridge what the 
self-indulgent consider its absolute necessaries, in order that, when he 
is cold in the grave, his wife, or his children, may be placed in circum- 
stances of ease and independence. Go, and do thou likewise." 

On the cemetery walls of St. John's Church at Basle a whole series of 
paintings illustrate the chances of death and the casualties of life from 



the minister to the maiden and from the wise man to the fool. The les- 
son taught by all of these interesting and instructive observations in 
their modern interpretation is the error of the past that the duration of 
life is conditioned by pure chance, and therefore beyond the control of 
man, and the resulting confusion of thought that though death is 
ultimately inevitable it is not generally unavoidable during a large por- 
tion of the allotted span of life. 

In the "Vision of Mirza," Addison has immortalized his conception 
of the bridge of life in the words : 

"I see a bridge," said I, "standing in the midst of the time." "The bridge thou 
seest," said he, "is Human Life; consider it attentively .... But tell me farther .... 
what thou discoverest on it." "I see multitudes of people passing over it," said I, "and 
a black cloud hanging on each end of it." As I looked more attentively, I saw several 
of the passengers dropping through the bridge into the great tide that flowed underneath 
it. 

Karl Pearson, in this connection, though himself the foremost exponent 
of scientijQc research into the underlying factors of the chances of living 
and dying, observes that "The shadow of death, more strongly even than 
blood or nation, maketh mankind akin; it arouses sympathy and under- 
standing, which surmount all the barriers of caste and station. The 
old Dances of Death supplied what fails so much in our modern life — an 
artistic representation appealing to all classes of at least one experience 
common to the whole of humanity."* 

The scientific study of death is called thanatology, and, as said by the 
late Roswell Park, who coined the term, it is a much neglected subject. 
The best modern treatise on the subject is by Charles S. Minot, published 
under the title "The Problem of Age, Growth and Death," in the Science 
Series of 1908. This is a study of cytomorphosis, or the conception that 
death is a function of age in its relation to the cellular changes of the 
body. Just as no one has as yet succeeded in providing an entirely 
satisfactory definition of life, so also there is no concise description or 
brief generalization of the terms "death" and "disease." We are not 
able to give an answer to the question as to how life originated, 
and it is quite probable that the riddles of life and death will prove 
continuous with the duration of human existence on the earth. 

The conception of death in modern life as a matter of pure chance has 
no doubt lost much of its earlier significance. The abject terror and 
the blind acquiescence common to periods of history when epidemic dis- 
eases destroyed vast numbers of lives within an incredibly short period of 
time have given way to an increasing faith and certainty in the 

*NoTE-^Among the more important contributions to the literature of the Dance of Death are: the Volume 
of Fac-simile Reprints of the Holbein Society, published London, 1869; Death's Doings, with 24 plates, by R. 
Dagley, published London, 1826; the Dance of Death by Holbein, published London, 1887; and the English 
Dance of Death, with 74 colored plates, by T. Rowlandson, published in the Illustrated Library of Plain and 
Colored Books, London, 1903. 



prolongation of human existence and the normal attainment of at least 
the Scriptural period of threescore years and ten. It is quite difficult 
for the modern mind to visualize effectively the terrible experiences 
passed through by the people of this country in the last years of the 
eighteenth century, when yellow fever prevailed as far north as Boston, 
New York and Philadelphia, or even in the middle of the nineteenth 
century, when the same dread disease devastated time and again the 
larger cities of the lower South. Cholera prevailed to the extent of an 
alarming epidemic in the City of New York in 1849, and as late as 1905 
yellow fever paralyzed the commerce of the South and brought sorrow 
and grief to the homes of many, from the throne of an archbishop to the 
hovel of the poor. It would serve no purpose to review on this occasion 
the sanitary history of the nation or to comment on the frightful waste 
of human life incident to the epidemics which in the past have devastated 
this land, hindered its material progress and brought sorrow and afflic- 
tion to the homes of helpless millions. Nor would it serve much of a 
purpose to recall the history of the Black Death of the fourteenth century, 
which, in all probability, was the most deadly pestilence in the history 
of mankind. Rather than, in the words of Hecker, the historian of the 
Black Death, "That Omnipotence, which has called the world with all 
its living creatures into one animated being, especially reveals Himself 
in the desolation of great pestilences," is it true to-day that such lament- 
able and destructive occurrences reveal human ignorance and human 
indifference, in contrast to realized intelligence and sanitary control. 
Rather than it being true, again in the words of Hecker, that "Nature 
is not satisfied with the ordinary alterations of life and death," and that 
pestilence and plague are revolutions "performed in vast cycles, which 
the spirit of man, limited, as it is, to a narrow circle of perception, is 
unable to explore," is the modern and incontrovertible fact that these 
recurrences, so characteristic of the past history of mankind, can be and 
are made impossible by a more rational mode of life, considered indi- 
vidually, and in the aggregate subject to intelligent acquiescence in the 
established truth of sanitary science and sanitary control. 

We are no longer seriously concerned with the possible risk of nation- 
wide epidemics, which are effectively guarded against by a national 
health service protecting the people against the introduction of plague 
and pestilence from abroad. Modern preventive medicine concerns itself 
chiefly with the spread of less destructive transmissible diseases, which 
still in the aggregate, however, cause a lamentable and largely needless 
loss of human life. The hygiene of transmissible diseases, their causation, 
modes of dissemination and methods of prevention, constitutes a branch 
of science than which none has yielded results of greater benefit to man- 



kind. Either the causation of such diseases or the mode of their spread 
from one person to another is now reasonably well understood, and the 
factors of transmission are controlled to a degree which falls little short 
of the miraculous. Most of the so-called preventable diseases are dimin- 
ishing in frequency in civilized countries, chiefly smallpox, typhoid fever, 
tuberculosis, diphtheria, measles, scarlet fever, whooping cough, malarial 
fever, etc. Some of these diseases are controlled by vaccination or pro- 
tective inoculation, as best illustrated in the marvelous results of typhoid 
fever prophylaxis in the United States army, by means of which the rate 
of frequency occurrence has been brought practically to a negligible quan- 
tity. Many of these diseases, however, are so widely diffused, and they 
are so complex in their relation to the human environment and the 
habits and customs of the human individual, that many years will pass 
before the death rate will be strictly normal, and one, on being born, will 
have a fair chance of attaining the maximum duration of life. But 
the future outlook for life extension is most encouraging, and there can 
be no question of doubt but that during the next generation a still further 
material reduction in the general death rate will be achieved. 

The Human Control of the Death Rate 

The discovery of a great truth serves no real purpose unless the new 
knowledge is realized in conduct and used in the solution of the problems 
of society. The realization of the ideal in health administration requires 
the intelligent, sympathetic and effective cooperation of all the various 
interests affected. The burden of responsibility for a high death rate 
falls, not on the medical profession, but largely upon the public itself, 
since the problems of sanitary control are largely and fundamentally 
a matter of government supervision and concern. The responsibility 
for life waste is one of inefficient citizenship, on the one hand, and of 
inefficient leadership and direction, on the other. The duty of direction 
and control is individual as well as social, and concerns the ministry of 
the spirit as much as it does the ministry of the body. The whole prob- 
lem of life conservation is condensed in the principle of Christian ethics, 
as laid down in Ecclesiastes vii:17, "Why shouldest thou die before thy 
time?" The answer is no longer a riddle of the universe, but a palpable 
truth obvious even to the ignorant in the light of modern knowledge. 
But the truth has come like a startling revelation to intelligent mankind, 
that pestilence, and even the common diseases of human life, are largely 
because of gross neglect, gross indifference, filth, ignorance and unwar- 
rantable delay in heeding the earliest symptoms of maladjustment in 
the human economy or the need of repair in the human machine. 
Problems of life and health are, therefore, matters of most serious con- 



cern to the clergy as well as to the physician, to the teacher as well as to 
the sanitary officer, and, in fact, in no relation of life is the Biblical doc- 
trine that we are all our brother's keeper more beautifully illustrated 
than in the chances of death and the ministry of health. Rigid con- 
formity to the truth of the causation of tuberculosis, of the spread of 
diphtheria by personal infection, of the contraction of smallpox by 
neglect of vaccination, of deaths from yellow fever because of contempt 
for the stegomyia mosquito, all prove the infinite possibilities of realizing 
life's larger purposes by the intelligent prevention of its needless waste. 
Instruction of mothers in the hygiene of infancy will effectively aid in 
solving the question as to whether the child will live and grow in strength 
of body and mind, just as rigid conformity to established principles of 
safety will protect the lives of passengers on land and sea. It is largely 
a question, first, of knowledge, then, of understanding, and, finally, of 
unswerving fidelity to the principles of truth as applicable to human 
conduct for the purposes of human betterment. 

The Increase in the Duration of Life 

The present annual death rate of the United States is only 13.9 per 
1,000, against a rate of 19.8 in 1880. The saving in years of life in conse- 
quence of a declining death rate is so enormous for a vast country like 
ours that the true meaning of statistical calculations can hardly be made 
intelligent to the average mind. Sooner or later every one must die, but 
the question is one of how long, on the average, each life can be made to 
last, when a gulf greater than the Atlantic or the Pacific separates the 
people who in one section live to an average age of 45 and in another to 60. 
Life tables illustrate with scientific precision God's law as applied to the 
tenure of man's existence on earth, but what is called the law of mortality 
is rather a symbolic expression of the law which governs all collective 
phenomena in the order of logical sequence, without which human ex- 
istence, and in fact all existence, would be chaos. A study of mortality 
problems reveals more accurately than many another branch of science 
the marvels of life in the aggregate as conditioned by the more or less 
perfect coordination of the units, whether merely physically considered 
or also in the broader sense of the psychological, moral and spiritual. The 
duration of life is determined by an almost infinite number of variants 
and even the wisest fail in the attempt to comprehend the whole. The 
diseases which afflict mankind are numerous, but most of the waste of 
life is due to a comparatively small number of causes, chiefiy, in our 
own country, tuberculosis of the lungs, accounting for 9.4 per cent, of 
the whole; organic diseases of the heart, accounting for 10.3 per cent.; 
acute nephritis and Bright's disease, accounting for 7.4 per cent.; 



pneumonia, accounting for 6.1 per cent.; and cancer, accounting for 5.6 
per cent. These six causes alone are responsible for 38.8 per cent, 
of the entire mortality. Other diseases, now largely under control but 
intrinsically as serious a menace to community life as any of those men- 
tioned, are typhoid fever, smallpox, measles, scarlet fever, whooping 
cough, diphtheria, etc. The typhoid death rate, which is typical of 
sanitary progress or neglect, has declined in American cities from an 
average of 51 per 100,000 of population during the decade ending with 
1892 to 25, or just about one-half, during the decade ending with 1912; 
but our typhoid fever rate is still excessive and no cause of death perhaps 
illustrates better the lamentable amount of still existing municipal neglect. 
Tuberculosis, the foe of mankind for ages, the disease par excellence, 
considered a visitation of God, has, during the last generation, been 
brought within the range of human control, with a fair prospect that 
within a measurable period of time its ravages will be reduced still more 
than has been the case in the recent past. The tuberculosis death rate 
of American cities during the decade ending with 1882 was 318 per 
100,000 of population, but the rate during the last decade was only 182. 
Within more recent years the mortality from smallpox has been reduced 
from an average of 3.4 during the five years ending with 1905 to a rate 
of only 0.3,, or about one-tenth of the earlier rate, during the year 1912. 
The mortality from the dread diseases of infancy, diphtheria and croup, 
has been reduced from an average of 2'9.6 during the five years ending 
with 1905 to 18.2 during the year 1912. We have no deaths from Asiatic 
cholera, nor from plague, except at quarantine stations subject to Federal 
control; either they are isolated or their introduction into this country 
is practically made impossible by means of a national health adminis- 
tration which challenges the admiration of the world. Yellow fever is 
no longer the foe of southern states, and we have had practically no 
deaths from the disease since 1905. Of leprosy we have a few cases 
annually, but excepting the well known leper settlements in Louisiana, 
there is slight danger to the country of a recrudescence of this perhaps 
most awful aJSQiiction of mankind. 

New Problems of Public Health 
But with the passing or control of the diseases which have become 
common knowledge, new ailments and afHictions cause new problems 
of serious importance, because the conditions of spread are either en- 
tirely unknown or but imperfectly understood. Influenza is one of these 
diseases, which, within recent years, appeared for the first time as a 
national scourge in 1891, causing directly or indirectly an enormous loss 
of life, and the disease has since prevailed to a more or less extent, either 

9 



as an immediate cause of death by itself or as a cause or condition 
complicating other diseases. Pellagra may be mentioned in this con- 
nection as one of the new diseases in this country, the nature and treat- 
ment of which are as yet rather doubtful, but the combined efforts of 
the Federal and State governments, aside from the aroused interest of 
the medical profession, are at work to determine the methods of control. 
The word "control," perhaps better than the word "prevention," gives 
expression to the human effort in the struggle of mankind against dis- 
ease and early death. No affliction of mankind to-day demands more 
serious consideration as a world menace than cancer, which has been 
increasing in practically every civilized country, and in the United 
States approximately at the rate of 25 per cent, during the last decade. 
Cancer, or malignant disease, is one of the most mysterious afSictions, 
and it is doubtful whether it will ever be traced to a single cause; it is 
more likely that it has its origin in a combination of causes and condi- 
tioning circumstances largely beyond the penetrating intelligence aided 
by the most powerful instruments of research. The present solution 
of the cancer problem is largely one of early diagnosis and the earliest 
possible surgical treatment, just as in fire-fighting the problem of con- 
flagration prevention is one of efficient apparatus, almost instantaneous 
notification and prompt response to established needs. 

Murder and Self-Murder 
The problems of life, disease and death are endless. The duty of 
applied intelligence in dealing with questions of preventable life loss and 
preventable disease is now so obvious on the part of every citizen, and 
most of all on the part of the leaders of community life in matters 
material, moral, intellectual or spiritual, that it seems hardly necessary 
to refer to the profoundly sorrowful phase of human existence 
which leads to murder or self-murder, to insanity and degeneracy, 
or the deliberate impairment, by wrongful conduct, of the physical and 
mental faculties, with resulting pathological consequences and early 
death, or decrepit old age. The suicide rate of American cities has in- 
creased from an average of not quite 13 per 100,000 of population during 
the decade ending with 1892 to almost 20 during the decade ending 
with 1912. More persons die from murder and self-murder in this 
country every year than from either typhoid fever or diphtheria 
and croup. The annual loss of life on account of suicide in the 
United States may be conservatively placed at 15,000, and the average 
age of these unfortunates is approximately twenty years less than 
that in deaths from cancer. The subject of suicide has at all 
times attracted the attention of moralists and of spiritual leaders, 

10 



but considering the awfulness of the crime of self-murder against God 
and man, it is a reflection upon our intelligence, our morality and our 
conceptions of religious duty that so little should be heard in protest 
against this perhaps the most sad and sorrowful phase of human life. 
The defence of suicide among the Stoics never gained ground among 
civilized peoples, but there has grown up a toleration and indifference, 
than which there is hardly anything more deplorable in our present-day 
period of what we are pleased to speak of as civilization. It has very 
beautifully been observed in this connection by a writer on self-murder, 
over two hundred years ago, that, "Whatever the end of human life is, 
what disputes soever there may be concerning it; it is not the destroying 
it; since nothing can have being given to it only in order to be not being." 
There is no more fitting subject for religious discourse than the sanctity 
of human life, the inviolability of the human person, the duty of facing 
life's problems with courage and the ministry of suffering and sorrow as a 
means towards a more perfect spiritual attainment. There is nothing 
more deplorable in America than the contempt for life, as made evident 
by the waste of 15,000 lives through self-murder, and, in addition 
thereto, more than 6,000 lives ended each year by the murderous 
actions of others. The phenomena of murder and self-murder emphasize 
the practical value of a thorough understanding on the part at least of all 
those who are the responsible leaders in morality and religion of the 
elementary principles of law in the civil sense of the term, of the dis- 
orders of conduct biologically considered, of unsoundness of mind and 
the border-land of insanity. 

Moral Significance of Life Extension 

In other words, the conservation of human life and health, or, as said 
by Prof. Irving Fisher, the problem of life extension, is not only of 
economic, but also of great moral significance. The perfection of human 
character is, partly at least, conditioned by the maximum attainable 
duration of life, and old age is as essential to human development, moral 
and spiritual, as is the secular and religious education of youth. 

Economic Aspects of Disease 

Prolonged sickness, considered from this point of view, is frequently 
the cause of human failure, and premature death often terminates need- 
lessly a most promising life. Sickness from preventable diseases is 
largely the result of social or individual indifference and neglect, but 
throughout the civilized world the importance of an effective sanitary 
administration is being recognized and the principles of sanitary science 
are being locally applied, with increasing evidence of beneficial results. 

11 



Required Cooperation for Social Control 

The cooperation of the church has for some years been successfully 
enlisted in the nation-wide effort in behalf of the ministry of health. 
It has become the custom on the part of the churches to set aside at 
least one or two Sundays a year for emphasizing the importance of some 
great public health question, particularly, on the one hand, the need of 
adequate support for hospitals and other institutions of aid and relief 
and, on the other, the urgency of financial and personal cooperation in 
the fight against tuberculosis. It would not seem to be going too far, 
therefore, to suggest that this principle of active cooperation should 
be extended and made to include a more frequent, though perhaps but 
incidental, discourse on other lamentable phases of human life, par- 
ticularly, as previously said, the sorrowful and wholly irreligious in- 
difference to the sanctity of human life, as evidenced in the increasing 
tendency towards murder and self-murder. 

Problems of Motherhood and Infant Mortality 

This view can be carried further and made also to apply to the unborn 
generations, or the sanctity of marriage as an institution primarily 
established for the preservation of the family and the continuity of the 
species. It can no longer be questioned that a vast amount of wrongful 
conduct underlies the persistent and considerable decline in the birth 
rate, and it can also not be questioned that a considerable portion of this 
decline is but life destruction, or murder under another name. Igno- 
rance, however, is the cause of far more waste of child life than 
deliberate crime, and the still enormous mortality of infants forcibly 
suggests the necessity for radical changes in the education of young 
men and women preparatory to marriage and parenthood. Out of 
every 1,000 persons born, approximately 125 die during the first year 
of life, largely because of the gross and inexcusable ignorance of mothers 
whose training in the essentials of motherhood was unhappily- neglected. 
But much of this loss of life is the result of sanitary inefficiency, of 
a polluted milk supply, on the one hand, and not infrequently of medical 
incompetence, on the other. 

The Ministry of the Visiting Nurse 

One of the most efficient aids in the campaign against infant mortality 
is the Visiting Nurse, assisting the young mother in the proper care 
of the child and providing the required skilful assistance at a period 
than which there is none other so trying in a woman's life. The 
visiting-nurse movement is entitled to the most hearty moral and 
financial support, for the results of an efficient public nursing service 

12 



benefit the children as well as the aged and those suffering from 
slight ailments as well as those suffering from serious afflictions. 

Problems of Child Care 

No subject appeals more powerfully to the sympathies of mankind 
of every degree than the physical sufferings of little children born with 
permanent defects in body or mind, and for all the years of their exist- 
ence more or less a burden to society. No institution serves a more 
humane purpose than the orthopedic hospital, where the afflictions 
of the congenitally deformed, by means of skilful surgery, are reduced 
to a minimum of physical suffering and physical incompetence; where, in 
fact, the lame are frequently made to walk, just as in the correspond- 
ing institutions for the blind, the deaf and the dumb, the defects of 
nature are partly made good by the skill of man. The institutional 
phase of modern life is one of increasing importance, for the limitations 
of the home frequently preclude adequate treatment and care under 
the best possible conditions. The natural reluctance of parents to part 
with their children or of families to submit to the seclusion of a much 
beloved member in an institution for the treatment or cure of some 
mental or physical defect requires the strongest moral and spiritual 
support from those who are in the best position to give advice and lend 
a hand. In all such cases a reasonably thorough understanding of 
the fundamental facts of human life, the chances of death, the rate 
of disease frequency, the possibilities of cure, all combine to further 
the higher purposes of society and bring about gradually, in however 
small a degree, the much required improvement in the conditions under 
which we live. 

Alcoholism and Habit-Forming Drugs 

Perhaps no problem of modern life is more serious in its moral and 
economic significance than alcoholism and the use of habit-forming 
drugs. If there is any one lesson taught by modern research into the 
biological laws which govern age, growth and death, it is that the human 
organism can not be abused or misused without the risk of most serious 
consequences and the practical certainty of physical impairment and 
premature death. The evidence is entirely conclusive that over- 
indulgence in alcoholic drinks is a fruitful cause of disease and moral 
depravity, while habit-forming drugs, including the misuse of tobacco, 
often and needlessly change a hopeful career into a hopeless human 
wreck. The most salutary influence is exercised by those who, by their 
own example, emphasize the value of right living, but this conclusion 
applies not only to moderation in the use of intoxicating drink, and 
much of what goes with it, but also to personal abuse or lack of 

13 



restraint of every other kind, especially the pernicious habit of over- 
eating, than which there is probably no more fruitful cause of bodily 
misery and premature physical decreptitude. It has been conclusively 
shown that those who are overweight live shorter lives and are more 
liable to diseases — possibly including one of the worst of human afflic- 
tions, that is, cancer — than do those who live abstemious lives, are 
careful in their diet and exercise restraint. The latter not only live 
longer, but, in the sum total of their years, enjoy a larger share of 
wellbeing than those who live contrarily to the obvious laws which 
govern the duration of the span of life allotted to us on earth. 

Healing Power of Faith and Prayer 

The problem of life and death is not only concerned with the things 
that are real but also with the innumerable imaginary and often abnormal 
fears, pains and diseased conditions of the body and mind resulting from 
the subtle but well established interrelation of the two. Of recent years 
new principles of therapeutics have been recognized, which range all the 
way from hypnotism to Christian Science. No one can question that 
there is therapeutic power in genuine faith as well as in fervent prayer. 
There is much unsoundness of mind and body due to other than physical 
causes, largely imaginary, no doubt, but just as real, and possibly more 
so, as the physical afflictions, which affect the body alone. From the 
uttermost depths of mental depression or melancholia to the utter- 
most heights of mental exaltation or mania, the human soul suffers 
infinitely more than the human body, and the agencies of relief must 
naturally be spiritual rather than physical. There is, therefore, a large 
field of usefulness in the ministry of health, which includes the ministry 
of the spirit, or of the mind diseased or in distress and in need of spiritual 
healing, as much as, or more than, it is in need of the aid of medicine as a 
healing art. This function of the Church is fortunately being recognized 
to an increasing extent, and while there no doubt have been much gro- 
tesque misuse of the opportunity and much downright charlatanism 
in the name of the holiest in Christian faith, there can be no doubt of the 
efficacy of spiritual healing in the furtherance of the larger cause of pro- 
moting the gospel of a healthy spirit in a healthy body. 

The Function of Old Age 

Every agency or effort making for health improvement necessarily 
makes for a prolongation of life. Such prolongation of life is of variable 
value, according to the age period affected, and while humanely most 
obvious in infancy and early youth, it is economically most useful during 
the productive period of life, and spiritually in the later years, when the 

14 



approach of natural death makes contemplation upon the problems of 
immortality, and possibly bodily survival after death, an imperative 
duty, the discharge of which can no longer be relegated to a future which, 
with certainty, we know is not to be. The utilization of old age, whether 
economic, social or spiritual, is one of the most neglected phases of 
modern life. The neglect has its origin in the fact that in past genera- 
tions relatively so small a proportion born attained to real old age that, 
as a practical question, the matter received only academic considera- 
tion. With the lowering of the death rate and the increasing average 
duration and the necessarily larger proportion of persons living into the 
third generation, this problem of old age and its proper utilization is, 
from many points of view, one of the most important of the time. The 
question need not be discussed here further, but it is sufficient to have 
pointed out its practical igmportance to the Church as well as to the State. 

The Problem Restated 

The present population of the United States is not far from 100,000,000. 
The number of persons of both sexes, ages 70 and over, in 1910 was 
2,270,021. According to the latest English life tables, out of every 
million born 277,351, or 27.7 per cent., may normally expect to reach 
the age of threescore and ten. In the United States the annual num- 
ber of births is about 2,500,000, and the annual number of deaths is 
about 1,350,000. Of those who died during 1912, approximately 
236,500, or 17.6 per cent., had lived less than one year, and 329,400, or 
24.4 per cent., had lived less than five years. 

The principal causes of death, in the order of their numerical import- 
ance and the approximate annual mortality therefrom are as follows: 
first, tuberculosis, which affects every period of life and causes in the 
aggregate about 154,000 deaths; second, heart diseases, also affecting 
every period of life, but chiefly ages over 40, causing a mortality of about 
150,000; third, nervous diseases, which account for about 138,000 deaths; 
fourth, pneumonia (all forms), about 132,000; fifth, intestinal diseases, 
about 123,000; and, sixth, genito-urinary diseases, about 111,000. 
Following these six, in the order of importance, are accidents, 
causing about 182,000 deaths; and tumors, malignant and benign, 
about 75,000. These eight groups of causes combined account for 
about 72 per cent, of the aggregate mortality of the United States, which, 
as previously stated, is approximately 1,350,000 per annum. Other 
important causes are typhoid fever, the mortality from which is about 
20,000 per annum; suicides, numbering approximately 16,000; deaths 
from parturition, about 15,000; and homicides, of which there are from 
six ip seven thousand. 

This may be considered the normal mortality of a civilized coun- 



15 



try not subject to exceptional or uncontrollable mortality condi- 
tions, such, for illustration, as continue to affect a great country like 
India even at the present time. The death rate of the registration area 
of the United States during 1912 was only 13.9 per 1,000, against a 
death rate of 32 for British India. Of the 7,500,000 deaths, in round 
numbers, during the year 1911, 354,000 were caused by cholera, 58,000 
by smallpox, 733,000 by plague, and 4,200,000 by fevers. Most of these 
causes are no longer an affliction of modern civilized countries, and they 
are fortunately brought slowly under control in the Indian Empire, 
where the death rate has gradually been reduced from extraordinary 
proportions to a rate not much above the normal for the large cities of 
this country fifty years ago. The best illustration of India's marvel- 
ous sanitary progress is to be found in the reduction of the death rate 
of the European army during recent years. Military discipline and 
conformity to sanitary rules and regulations, no doubt, largely account 
for this reduction, which has been of immeasurable benefit, not only to 
the European but also to the native population. 

Public Health and Christian Ethics 

The principles of longevity are better understood to-day than at any 
time in the past. The duty of rigorous conformity on the part of the 
individual to the teachings of public and personal hygiene is no longer 
debatable. The facts and conclusions here advanced emphasize the 
great practical importance of a thorough and general understanding of the 
forces and conditions which make for human betterment through the 
ministry of health, conceived as a profound social duty, a personal obH- 
gation and a spiritual necessity, and as such indispensable for the fur- 
therance and the ultimate attainment of the highest ideals of Christian 
citizenship . 



16 



Table I 

Deaths from All Causes, U. S. Registration Area, 1900-1912 

T> 1 1- T-i 11, Rate per 1,000 

Year Population Deaths of Population 

1900 30,765,618 539,939 17.6 

1901 31,370,952 518,207 16.5 

1902 32,029,815 508,640 15.9 

1903 32,701,083 524,415 16.0 

1904 33,345,163 551,354 16.5 

1905 34,052,201 545,533 16.0 

1906 41,983,419 658,105 15.7 

1907 43,016,990 687,034 16.0 

1908 46,789,913 691,574 14.8 

1909 50,870,518 732,538 14.4 

1910 53,843,896 805,412 15.0 

1911 59,275,977 839,284 14.2 

1912 60,427,133 838,251 13.9 



Table 11 
Principal Causes of Death in the United States 

Registration Area Estimate for 

1908-1912 Continental 

Rate per United States 

Number 10,000 During 1913 

Population Number 

Tuberculosis 431,118 15.9 153,818 

Heart Diseases 421,580 15.5 150,374 

Pneumonia (all forms) ....... 369,966 13.6 131,988 

Intestinal Diseases. 345,186 12.7 123,086 

Nephritis 265,665 9.8 94,782 

Accidents 230,679 8.5 82,348 

Cancer 202,621 7.5 72,284 

Apoplexy 198,657 7.3 70,832 

Liver Diseases 61,694 2.3 22,063 

Bronchitis 60,068 2.2 21,385 

Arterial Diseases 59,036 2.2 21,056 

Typhoid Fever 57,208 2.1 20,417 

Diphtheria and Croup 54,118 2.0 19,304 

Stomach Diseases 52,163 1.9 18,579 

Suicides 44,602 1.6 15,908 

Parturition 42,081 1.6 15,008 

Diabetes 39,188 1.4 13,934 

Insanity 24,010 0.9 8,563 

Diseases of Generative Organs 17,588 0.6 6,271 

Homicides 16,908 0.6 6,028 

All Other Causes 912,923 33.9 277,014 

All Causes 3,907,059 144.1 1,345,042 



17 



Table III 
Death Rate* per 1000 Population, 1911, for the Registration States of 1900 

Ages Both Sexes Males Females 

All ages: 

Crude rate 14.9 15.8 14.0 

Corrected ratef 14.6 15.3 13.9 

Under 1 year 125.5 138.6 112.1 

1-4 years 12.8 13.3 12.2 

5-9 years 3.2 3.4 3.1 

10-14 years 2.2 2.4 2.1 

15-19 years 3.5 3.7 3.3 

20-24 years 5.0 5.3 4.7 

25-34 years 6.3 6.7 6.0 

35-44 years 9.4 10.4 8.3 

45-54 years 14.5 16.1 12.9 

55-64 years 28.4 30.9 26.0 

65-74 years 58.3 61.6 55.1 

75 years and over 143.0 147.4 139.2 

* Exclusive of still-births 

t Based on standard million of England and Wales, 1901 



Table IV 

Principal Causes of Death in the United States Registration Area, 1903-1912 
Death Rates per 10,000 of Population 

1908 1909 1910 1911 1912 ^j^?,^^' '^^^^^ 

Tuberculosis 16.8 16.1 16.0 15.9 15.0 18.7 15.9 

Heart Diseases 14.9 15.1 15.9 15.7 16.0 15.2 15.5 

Stomach and Intestinal Diseases 15.9 15.0 16.4 13.6 12.9 16.2 14.6 

Pneumonia (all forms) 13.1 13.8 14.8 13.4 13.2 15.5 13.6 

Nephritis 9.4 9.5 9.9 9.8 10.3 10.1 9.8 

Accidents 8.8 8.7 8.4 8.5 8.2 8.9 8.5 

Cancer 7.2 7.4 7.6 7.4 7.7 7.0 7.5 

Apoplexy 6.9 7.2 7.4 7.5 7.6 7.1 7.3 

Liver Diseases 2.3 2.3 2.3 2.3 2.2 2.5 2.3 

Bronchitis 2.6 2.4 2.3 2.0 1.9 3.3 2.2 

Arterial Diseases 1.7 2.0 2.2 2.3 2.6 1.4 2.2 

TyphoidFever 2.4 2.1 2.4 2.1 1.7 3.1 2.1 

All Causes.. 147.8 144.0 149.6 141.6 138.7 160.3 144.1 



18 



Table V 



Deaths in British India, 1901-1910 





ALL CATTSES 






CHOLERA 






Rate per 




Rate per 


Year Number 


10,000 


Year Number 


10,000 




Population 




Population 


1901.. 


.6,606,387 


294.6 


1901.. 


. 271,210 


12.1 


1902. . 


.7,112,336 


314.9 


1902. . 


. 224,136 


9.9 


1903.. 


.7,881,125 


347.0 


1903. . 


. 312,854 


13.8 


1904 . . 


. 7,436,472 


328.6 


1904. . 


. 192,835 


8.5 


1905 . . 


.8,117,771 


359.6 


1905. . 


. 441,786 


19.6 


1906. . 


.7,852,330 


347.3 


1906. . 


. 690,519 


30.5 


1907.. 


.8,399,623 


371.8 


1907.. 


. 408,102 


18.1 


1908 . . 


.8,653,007 


382.2 


1908. . 


. 591,725 


26.1 


1909.. 


.6,998,044 


309.1 


1909. . 


. 239,231 


10.5 


1910. . 


.7,518,034 


332.0 


1910. . 


. 430,451 


19.0 


SMALLPOX 




PLAGUE 




1901 . . 


. 89,385 


4.0 


1901.. 


. 237,688 


10.6 


1902. . 


. 115,443 


5.1 


1902.. 


. 456,975 


20.2 


1903.. 


. 93,693 


4.1 


1903. . 


. 686,485 


30.3 


1904. . 


. . 55,232 


2.4 


1904. . 


. 940,609 


41.6 


1905.. 


. . 70,962 


3.1 


1905. . 


. 940,821 


41.7 


1906. . 


. . 109,583 


4.8 


1906.. 


. 300,355 


13.3 


1907.. 


. . 103,988 


4.6 


1907. . 


.1,166,223 


51.6 


1908. . 


. . 170,694 


7.5 


1908.. 


. 113,888 


5.0 


1909.. 


. . 101,152 


4.5 


1909. . 


. 145,333 


6.4 


1910.. 


. . 51,315 


2.3 


1910.. 


. 413,355 


18.3 


FEVERS 




DYSENTERY 




1901. .. .4,174,919 


186.2 


1901 . . 


. 247,190 


11.0 


1902. . 


. .4,279,351 


189.5 


1902.. 


. 235,750 


10.4 


1903.. 


..4,459,237 


196.6 


1903.. 


. 273,459 


12.1 


1904.. 


. .4,093,981 


180.9 


1904 . . 


. 240,655 


10.6 


1905 . . 


. .4,417,655 


195.7 


1905.. 


. 264,124 


11.7 


1906. . 


. .4,452,842 


196.9 


1906. . 


. 298,117 


13.2 


1907.. 


. .4,464,881 


197.6 


1907.. 


. 282,191 


12.5 


1908. . 


..5,424,372 


239.6 


1908.. 


. 285,921 


12.6 


1909.. 


. .4,487,492 


198.2 


1909.. 


. 216,956 


9.6 


1910. . 


..4,341,392 


191.7 


1910. . 


. 267,672 


11.8 



Table VI 
Death Rate of European Troops in India, 1801-1911 

Rate Rate 

Years per Years per 

1,000 1.000 

1801-30 84.6 1891-00 16.2 

1831-56 57.7 1901-05 12.2 

1861-65 26.9 1906-09 8.7 

1870-79 19.3 1910 4.7 

1881-91 14.2 1911 4.9 

19 



LIBRflRV OF CONGRESS 



013 735 026 9 % 



THE PRUDENTIAL 

INSURANCE COMPANY OF AMERICA 

Incnrporated as a Stock Company by the State of New Jersey 




FORREST F. DRYDEN, President 

HOME OFFICE, NEWARK, NEW JERSEY 



